- Laurie Goodman, RN, MHScN, IIWCC (CAN)
- R. Gary Sibbald, BSc. Md. M.Ed., D.SC (Hon), FRCPC (Med)(Derm), FAAD, MAPWCA, JM
This chapter is intended to guide health care clinicians and students through the important and dynamic skill of managing moisture for patients with chronic wounds. The classifications of healability will be applied to various desired moisture levels for optimal patient outcomes. Appropriate use of antibacterial and antiseptic products along with correct selection of dressings according to their form and function are expanded on. The Wound Bed Preparation paradigm (Sibbald, et al, 2021) in combination with relevant literature and expert opinion are presented in this chapter to assist the reader to apply clinically.
- Review moisture management strategies in the context of wound healing classifications (healable, nonhealable & maintenance)
- Examine the use of topical antimicrobials and antiseptics to facilitate appropriate moisture management
- Apply wound assessment findings to dressing form and function features
Moisture Management is a collective term where providers utilize their skilled clinical eye, astute assessment skills, a working knowledge of the accessible wound care product formulary while taking into account the patient’s perspective. “Moisture management” has evolved along with evidence informed wound care practices and has now replaced the former term “moisture balance”. Determination of the correct moisture level is now viewed as a dynamic and adaptable process as the wound moves through various appearances along the way. The former term, moisture balance, suggests an approach that balances all wounds at the similar level between moist and dry. This is still the case for a healable wound where that ideal level of moisture needs to be “balanced”. The new term considers that the nonhealable / maintenance healability classifications need to be managed differently.
The Wound Bed Preparation framework (Sibbald et al, 2021) guides health care providers of individuals with a wound, through a holistic patient-centered assessment, diagnosis and treatment algorithm. This structured, evidence-based approach will direct the provider and patient to optimal wound care. The 2015 WBP (Sibbald et al, 2015) added a crucial the step of determining the healability of the patient with a wound as either: healable, nonhealable or maintenance. Once the cause has accurately been confirmed and patient centered concerns have been accounted for, then the healability classification of the wound can be determined. A review of healable, nonhealable and maintenance healing classifications will be outlined in the context of moisture management.
Local wound care in the WBP algorithm includes the D, I, M, E approach (Debridement, Infection / Inflammation and Edge Effect) that will be covered in other chapters. This chapter focuses on the “M” for Moisture management in its application for chronic wounds along with various modifying factors. Moisture management means moisture balance for healable wounds and moisture reduction for nonhealable or maintenance wounds.